Gender( for single skating): r female r male

Entry form

Name,Surname: _________________________________________________________

Name,Surname(partner): __________________________________________________

Gender(for single skating): r female r male

Date of birth_____________________________________________________________

Country, City: ____________________________________________________________

Phone: ______________________________ E mail: ________________________

Home club: __________________________ Coach: ________________________

I/We will compete in:

r Single skating:

r Bronze Free Skating r Silver Free Skating r Gold Free Skating r Master Free Skating

r Class I (born 1.07.1975-30.06.1985) r Class II (born 1.07.1965-30.06.1975) r Class III (born 1.07.1955-30.06.1965) r Class IV (born 1.07.1945-30.06.1955) r Class V (born 1.07.1935-30.06.1945)

r Single Artistic Free Skating

r Bronze Free Skating

r Silver Free Skating

r Gold Free Skating

r Master Free Skating

r Pair Free Skating:

r Adult Pair Skating

r Master Pair Skating

r Ice Dance:

Pattern Dance Free Dance

r Bronze r Bronze

r Silver r Silver

r Gold r Gold

r Master r Master

PLANNED PROGRAM CONTENT

Club
Country, City
Name of competitor(s),Level,Class

Elements in Order of Skating

Music time total	Free Skating Elements\Free Dance	Music time total	Artistic Skating Elements\ Short Dance

Music of FS/FD: _________________________________________________________________

Author: _______________________________________________________________________

Music of Artistic skating/SD: ______________________________________________________

Author:________________________________________________________________________

Fees

Entry fees

r 1^st Single Event 65 Eur per person

r 2^nd Single Event 40 Eur per person

r 1^st Dance/Pair Event 40 Eur per person

r 2^nd Dance/Pair Event 30 Eur per person

r 3d Dance/Pair Event 25 Eur per person

r Synchronized Team 500 Eur per team

TOTAL _______________

Others

r I wish to have a training (45 minutes off-ice practice + 45 minutes ice practice) in a group up to 10 skaters on Friday, June 6, 2014 (€ 25 per skater). (The possibility of trainings on the other days to be announced)

r I wish to take part in a Master-class on Friday, June 6, 2014 *

r I wish to purchase a Photo shooting of my performance *

r I wish to take part in a Closing On-Board Banquet *

LIABILITY

In accordance with ISU Rule 119 regarding Medical Insurance and ISU Rule 141 regarding Safety, the Russian Federation, the Figure Skating Federation of Saint Petersburg, School of Figure Skating Spartak and the ISU take no responsibility for liability with respect to bodily or personal injury or property loss or damage incurred by competitors or officials. Each entrant is expected to provide his/her own insurance. The organizer will provide medical services for all competitors and officials during practice and competition.

I, the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician. It is my responsibility to notify the Organizer of any change in health condition between the date of the close of entries and the competition. I acknowledge that I am aware of all the risks inherent in figure skating and agree, on behalf of myself and my family, to assume those risks. As a condition of my participation in the International Adult Figure Skating Competition or any activities incident thereto, I hereby waive any and all rights to claims for loss or damages caused by the negligence, active or passive, of the ISU, the Figure Skating Federation of Saint Petersburg, School of Figure Skating Spartak, and my entry shall be accepted only on the basis of this waiver. I have read, studied and understood the content and criteria of this form and I accept with my signature the above-mentioned conditions.

Participant's Signature: ________________________________

Signature of participant required and this waiver must be included in application package

* Fee for Master-class, Closing Banquet and Photo shooting to be announced.

Дата добавления: 2015-09-29